SHM Converge Scientific Abstract ePoster Gallery-Palm Tree Thorn Injury: An Unusual and Underestimated Cellulitis With Risk for Near Miss Event

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This case report describes a 60-year-old man who developed worsening left forearm pain and swelling after being struck by a palm tree frond. Although his initial emergency room X-ray showed no fracture or foreign body, his symptoms progressed over four days despite ice and elevation. On examination he was afebrile but had a large, raised, tender circumferential area with mild tingling. Laboratory studies were not strongly inflammatory. He was admitted for cellulitis related to palm tree injury and initially treated with cefazolin, colchicine, and prednisone.<br /><br />Because palm tree thorn injuries are often caused by plant-associated bacteria, his antibiotics were changed to ceftriaxone for better coverage of Pantoea agglomerans, a common pathogen in these injuries. Ultrasound was then used to evaluate for retained thorn fragments and identified a small linear foreign body. Incision and drainage later revealed pus and a long foreign object about 2 inches in length. Cultures grew Enterobacter cloacae and Enterococcus casseliflavus, organisms associated with plant material. He was discharged on doxycycline and cefdinir.<br /><br />The report emphasizes that palm tree thorn injuries can be underestimated and misdiagnosed as routine cellulitis. Retained thorns may migrate and lead to serious complications such as septic arthritis, synovitis, infected hematoma, osteomyelitis, bacteremia, and sepsis. The key management principle is early identification and removal of the foreign body, especially when symptoms do not improve with antibiotics. X-ray is often insufficient because thorns are radiolucent; ultrasound or MRI is recommended for faster detection.

Asset Subtitle

Kimone R Y Reid

Meta Tag

Author List Kimone R Y Reid

Category Clinical Vignettes

Concept Palm Thorn Injury

Concept Retained Foreign Body

Concept Foreign Body Removal

Concept Cellulitis

Concept Soft tissue infection

Distinguished Non-Finalist

Presenter Organization Cleveland Clinic Martin Health

Presenting Author Kimone R Y Reid

Track Adult

Keywords

palm tree injury

thorn foreign body

cellulitis

ultrasound detection

retained thorn

Enterobacter cloacae

Enterococcus casseliflavus

Pantoea agglomerans

incision and drainage

radiolucent foreign body

Palm Thorn Injury

Retained Foreign Body

Foreign Body Removal

Cellulitis

Soft tissue infection